PERFORMANCE: A significant change to care assessment in Oxfordshire aimed at reducing delayed transfers has led to an initial exacerbation of the problem.

The county has had the highest rate of delayed transfers in England for more than a year.

Clinical commissioning group board papers reveal that the introduction of a new approach to assessing frail elderly patients for post-discharge support was a “major contributor” to a rise in delays in the final quarter of 2012-13.

Patients are now being assessed for social care support in their homes, after discharge, rather than when they are still in hospital. The change is designed to speed up the transfer process, and lead to better packages of social care and community care support for patients.

The CCG describes its “whole systems discharge policy” as the “biggest change seen in Oxfordshire in recent years affecting the pathway of care.” Providers have implemented it in the past four months.

A CCG board paper from last month says: “Staff currently have to manage two systems as the pilot has not yet been fully implemented across all ward areas and there is limited infrastructure to support both systems.”

There were 183 delayed transfers in the county on 10 March, against a target of 72. The figure is a modest improvement on March 2012, when delayed transfers hit a high point of 201 in a single day.

Oxfordshire CCG chief executive Stephen Richards told HSJ other delayed discharge reduction measures implemented over the past six months were nearing maturity and beginning to have a positive impact. These include a “single point of access”, which enables clinicians to refer patients to community services, and is designed to cut demand for acute care.

Solving the delayed discharge problem would require several initiatives to succeed at the same time, he added.

Dr Richards said detailed discussions were continuing between the CCG and Oxfordshire County Council about pooling health and social care budgets. It is hoped this will be running in shadow form by October, and will include the CCG’s entire community health services budget.

The CCG is also working to move to contracts which are more focused on outcomes, Dr Richards revealed. These would focus on the three areas of mental health, maternity and the frail elderly.

The first two are planned to take effect in the current financial year and the third potentially in 2014-15.